EMR Launch Nightmares

Physician's Money Digest, Spring 2013, Volume 15, Issue 1

Once a practice has an electronic medical record (EMR) up and running, many practices say they see an improvement. Thanks to the new technology, 45 percent of physicians reported their practice is doing better this year compared to last year, according to Practice Fusion’s third annual State of the Small Practice report. And 62.9 percent of physicians say these new technologies continue to make practicing medicine easier.

The feedback is unsurprising, says Lydia Washington, MS, RHIA, CPHIMS, director of HIM solutions for the American Health Information Management Association. Anecdotally, she says she rarely hears about physicians who would go back to paper after using an EMR for a year or more.

“Once all the bugs are worked out — and maybe even before all the bugs are worked out — [physicians] can see that they and their staff are not spending as much time looking for information,” Washington says. “There really is some productivity improvement once you get over the learning curve.”

But the question is, once that EMR is up and running, how does the medical practice get back to a productive level? The post-launch answers reside in the pre-launch prep, according to Washington and other health information professionals.

Planning ahead

Washington says that time-wise there’s no rule of thumb for a post-launch examination. Much depends on the size of the practice, the diversity or different types of physicians employed at the practice, and how the EMR was implemented — all at once, or in stages. However, Washington says that implementation is really the key to post-launch analysis.

“All of the post-launch work is going to be dependent upon what you did in the pre-launch phase,” she explains. “How you did your readiness assessment, and whether or not you prepared adequately for things like training, backup and IT support. It’s not unusual to have some major glitches when you first go up with one of these things. I’ve seen organizations brought to their knees because they did not adequately plan upfront. You could be looking at as much as six months before you can do a post-launch.”

According to Washington, the more upfront work a medical practice does, the smoother and faster the post-launch return to productivity will be. That includes workflow analysis and assessment that, she says, a lot of practices either don’t perform or don’t execute sufficiently. Practices don’t take the time to understand their workflows and how they’re going to change.

“The other thing is that you really need to plan for some loss of productivity in those first days,” she says. “There’s a cost associated with that. And so you should build that into the plan. You can have the worst system in the world, but if you implement it properly, you might be okay.”

Back to productivity

So, how does a medical practice get back to productive levels following the launch of an EMR? Kari Hutchison, RN, senior advisor at health care information technology consulting firm Impact Advisors, says the most important aspect in getting back to a productive level is to get the proper amount of training while taking advantage of resources.

“Take whatever amount of training is required by the software vendor or host,” Hutchison explains. “Be sure to be fully present; get someone to cover patients and turn off your pager, if possible. Focus on the material.”

Washington agrees, noting that some hand holding on the part of the vendor immediately post-launch is essential.

“You need support from your vendor right there in the immediate aftermath,” Washington says. “It never ceases to amaze me how many doctors don’t think about this kind of stuff.”

And speaking of doctors, Hutchison says it’s usually recommended that providers work load is reduced during the weeks immediately after the EMR goes live. Hutchison says that while physicians are getting up to speed on the new system, they gradually build their patient load back up to normal from 50 percent.

“This [gradual build] allows physicians to thoroughly do their work and understand the workflow,” she says. “It also allows them to get up to speed more quickly because they have the time to put into the learning.”

Take measure

For comparison purposes, it’s important for a medical practice to accurately identify baseline metrics prior to implementation. These metrics can be quantitative or qualitative, and can help a practice determine when it might be ready to look at post-launch evaluations.

Hutchison says the metrics should be agreed upon by the vendor and the practice prior to the EMR going live. She also divides the metrics into two categories: subjective, and objective.

· Providers can easily navigate through the workflows

· Template tools are being utilized

· Patients feel comfortable during the exam, meaning that the computer has become a tool, not a focus

On the subjective side:

· Visit volume returns to or surpasses pre-implementation levels

· Addendums have increased over time from the launch day

· Revenue for the practice meets or exceeds pre-implementation levels

· Aging days decrease from pre-implementation levels

· The majority of orders (greater than 80%) are being entered electronically

· Providers are meeting Meaningful Use metrics, if that is the practice’s goal

· Office visits are being completed within scheduled timeframes, and wait times are decreasing

On the objective side:

Back-up plan

Washington says that too often she has seen medical practices go live with an EHR ER or EMR without an adequate back-up plan should the technology not be available.

“I’ve seen a few nightmares,” she explains. “You need a back-up system, as well as plans for falling back to paper if you have to.”

She also stresses that physicians and medical practice staff need to be patient.

“This is a major change,” Washington says. “Even in a one- or two-physician practice, a month is too soon. Three months, maybe. And the bigger the practice, the longer it will take.”